Letters |

Perceptions of Appropriateness of Care in the Intensive Care Unit

Soichiro Nagamatsu, MD; Kazuto Yamashita, MD
JAMA. 2012;307(13):1370-1372. doi:10.1001/jama.2012.393.
Text Size: A A A
Published online


To the Editor: Dr Piers and colleagues1 reported that many European and Israeli clinicians in intensive care units (ICUs) perceived that some patients were provided inappropriate care, and the most common reason was the provision of too much care. However, providing excessive care for patients with little hope for survival could be considered appropriate in certain situations. In Japan, for example, care in the ICU is affordable for citizens, with a maximum of approximately $1000 per month in co-payments under universal health care coverage. In addition, many citizens believe that providing all possible care works as karma for their family members. Furthermore, the Japanese Supreme Court handed down a guilty sentence to a physician who withdrew care from a comatose patient in 2009.2 As a consequence of such legal precedents, withdrawing care is extremely rare in Japan. Although some physicians do so secretly, risking the psychological burden that such actions entail, other physicians believe continuing care despite minimum hope for survival is appropriate, even knowing health care resources are scarce.3


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




April 4, 2012
Connie M. Ulrich, RN, PhD; Christine Grady, RN, PhD
JAMA. 2012;307(13):1370-1372. doi:10.1001/jama.2012.394.
April 4, 2012
Ruth D. Piers, MD, PhD; Elie Azoulay, MD, PhD; Dominique D. Benoit, MD, PhD
JAMA. 2012;307(13):1370-1372. doi:10.1001/jama.2012.395.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...